Anthem: "Nyoing nyang nyumpie. Vglibble vglobble vglup."*

Dear client,

 

With sincere, profound regret, I have been forced into a position where I must either transfer your case to another clinician, or close it, at your discretion. This has nothing to do with you or with our clinical relationship. Anthem Blue Cross / Blue Shield, your insurance provider, has recently adopted documentation requirements that I cannot, in good conscience, meet. Anthem’s new standards require a vacuous dumbing-down of therapeutic thinking and documenting, where a client’s complexity and interrelatedness of problems are gutted of psychology and reduced to measurable, numerical objectives and short- and long-term goals – reduced to a “sixth-grade math word problem,” as I said in a blog post. These concrete milestones must be named in a Treatment Plan and reflected in each session’s Progress Note. This requires the clinician * to perceive the client as one or two simple behavior changes waiting to happen rather than as a complex psyche with deep roots, * to use boilerplate terminology, and * to frequently fabricate – invent – indicators of either progress or stagnation for each session’s Note. This farce has nothing to do with the nature of therapeutic progress or how it happens, and is not something I can do as a caring, long-experienced counselor.

 

I’ll acknowledge that other counselors are able to comply with the new standards (especially interns).

 

Anthem, in what may be a fraudulent act, has not been paying Oasis Counseling for, I am assuming, hundreds of hours of sessions, as I am not the only clinician facing these absurd new requirements. I have lost a great deal of income – unfortunately, a significant factor – and my family has suffered for it in a near-calamitous way. Consequently, I am forced to remove Anthem from my panel of insurances and to make room for others which, at least for now, underwrite my services from an understanding of the ambiguity and complexity of clients’ difficulties and needs.

 

All Anthem clients who are presently on my calendar through January will remain on schedule. Special, individual needs will be respected, which could extend the closure process into the following month. As mentioned, you may ask me to transfer your case to another clinician.

 

-- The Pessimistic Shrink

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* John Barth, The End of the Road, page 70. Originally published in hardcover by Doubleday in 1958. Copyright © 1958, 2016. Some context: "He mugged antic faces at himself, sklurching up his eye corners, zbloogling his mouth about, glubbling his cheeks. Mither Morgle. Nyoing nyang nyumpie. Vglibble vglobble vglup. Vgliggybloo! Thlucky thlucky, thir."